Provider Demographics
NPI:1700067097
Name:MY M. VUONG, O.D.
Entity Type:Organization
Organization Name:MY M. VUONG, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MY
Authorized Official - Middle Name:MY
Authorized Official - Last Name:VUONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-295-5640
Mailing Address - Street 1:6512 N DECATUR BLVD STE 130-234
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1046
Mailing Address - Country:US
Mailing Address - Phone:702-433-2010
Mailing Address - Fax:
Practice Address - Street 1:6464 N DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-2959
Practice Address - Country:US
Practice Address - Phone:702-433-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center